The Tao Clinic for Fertility Acupuncture and ART Physiology, Research and Standard of Care The Tao Clinic for Fertility Somewhere USA Add you own info, back ground and images

TCM and Infertility A Historical Perspective 2000 years of written records Recorded extraction of male and female hormones in China 2nd century B.C. First book published on gynecology was in 1237AD Phagocytosis and cellular immunity were discovered less than 75 years ago 75 years of modern Chinese hospitals integrated with traditional Chinese medicine To give TCM its due we need to look at it’s history. Many prescriptions used in TCM have been record in texts that are over 2000 yrs old. A quaint fact if some of the formulas weren’t in successful use today. Many people talk about the how one modality or the next has stood the “test of time”. But if we look at what we have accomplished in the last 100 years in Allopathic medicine like the fact the cellular immunity and phagocytosis were discovered less than 75 years ago and think about what the Chinese have learned from 75 years of integrating CAM and allopathic medicine in so many of their hospitals we understand there might be something for us to explore. If TCM is not effective does anyone believe that after 75 years they could still be used in the modern Chinese hospitals? Food for thought or one might say herbs for thought!

Proposed Physiological Mechanisms for Acupuncture Modulates regulatory systems Sympathetic E Sterner -Victorin et al. (2008). “Acupuncture in Polycystic Ovary Syndrome: Current Experimental and Clinical Evidence”. Journal of Neuroendocrinology, 20, 290-298. Endocrine S. Anderson, T. Lundeberg, (2009). “Acupuncture - from empiricism to science: Functional background to acupuncture effects in pain and disease”. Medical Hypothesis, 45 (3), 271-281 Neuroendocrine Cai X. Substitution of acupuncture for human chorionic gonadortropin in ovulation induction. J Tradit Chin Med 1997;17:119-21. Chen et al., Acupuncture normalizes dysfunction of hypothalamic-pituitary-ovarian axis. Acupunct Electrother Res 1997;22:97-108 Acupuncture modulates endogenous regulatory systems including the sympathetic nervous system, and the neuroendocrine system is most likely mediated via the endogenous opiod system, in particular beta endorphin Acupuncture excites nerve fiber or receptors in the stimulated tissue similarly - but more precisely - than protracted exercise. This in turn causes the release of beta-endorphins, and clinical and experimental evidence suggests that acupuncture may affect the sympathetic nervous system via mechanisms at the hypothalamic and brainstem levels Several studies have shown the positive effects of acupuncture on plasma levels of FSH, LH, E2 and P. Acupuncture’s physiologic mechanisms related to subfertility are believed to be related to central sympathetic inhibition by the beta-endorphin system, improvements in uterine blood flow and haemodynamics, as well as stress reduction/relaxation. In addition, numerous small case studies and non-controlled or insufficiently powered trials have shown beneficial effects for acupuncture related to male factor infertility. Though the study size and design of the current research on acupuncture is insufficient there is enough evidence to warrant further study. The doctors at the Center for Reproductive Medicine and Infertility at Cornell University published a study which concluded that although the definitive role of acupuncture in the treatment of female infertility is yet to be established, its potential impact centrally on the hypothalamic-pituitary-ovarian axis and peripherally on the uterus needs to be systemically examined. Furthermore, because acupuncture is nontoxic and relatively affordable, its indications as an adjunct in assisted reproduction or as an alternative for women who are intolerant, ineligible, or contraindicated for conventional hormone induction of ovulation deserves serious research and exploration.

Acupuncture Research Stener Victorin et al., (1996) “Reduction of blood-flow impedance in the uterine arteries of infertile women with electro-acupuncture”. Human Reproduction, 11(6), 1314-1317. Reduction of blood flow impedance in the uterine arteries of infertile women with electro-acupuncture PI

Acupuncture Research Pre and Post Acupuncture treatment Paulus et al., (2002). “Influence of Acupuncture on the pregnancy rate in patients who undergo assisted reproductive therapy”. Fertility & Sterility, 77(4), 721-724. Acupuncture vs. Non Acupuncture with IVF Pre and Post Acupuncture treatment 160 patients, 80 Ac and 80 C 42.5% Ac v. 26.3% C Repeated with Sham Acupuncture 43% Ac v. 37% C With p=.03 The first big splash of TCM and Infertility happened in 2002 when Paulus et al conducted an RCT that showed higher clinical pregnancy rates (p=.03) in the acupuncture treatment group, than in the control group

} Acupuncture Research Acupuncture’s Impact on Poor Responders +11% Magarelli et al., (2004). “Acupuncture and IVF poor-responders: a cure?” Fertility & Sterility, 81(3), 20. Rates/Transfer (%) } +11% In 2004, Magarelli et al, retrospectively assessed the affect of acupuncture in a poor-prognosis IVF population. Although not an RCT, pregnancy rates for the acupuncture group were 53%, and 38% for the non-treatment group. Demonstrated synergistic effect of both protocols. Demonstrate that the use of acupuncture in patients with poor prognoses can achieve similar pregnancy rates to normal prognosis patients. For Poor Responder IVF patients, pregnancy rates were “corrected” to match Good Responders. Birth Rates were improved by 11% in those patients receiving both IVF and Acupuncture! This we believed was due to fewer miscarriages and no ectopic pregnancies in the IVF + Acupuncture groups.

Acupuncture Research In 2008 Manheimer, et al., performed a Meta Analysis through the Cochrane database of RCT’s for acupuncture and IVF. Their Meta Analysis concluded that acupuncture increased the odds ratio of clinical pregnancy rates by 65%. More interestingly, the authors found that acupuncture increased the odds ratio for live birth by 91%. Manheimer,, et al. (2008). “Effect of Acupuncture on rates of pregnancy and live-birth among women undergoing in-vitro fertilization: A systematic review and meta-analysis”. BMJ, e-published ahead of print. In 2009, Magarelli, et al.,performed a prospective cohort clinical trial that looked for other possible physiological mechanisms by which acupuncture might increase clinical pregnancy rates in IVF. Their conclusion was that “there appears to be a beneficial regulation of both cortisol and prolactin during the medication phase of IVF with a trend toward more normal fertile-cycle dynamics”. Magarelli, P, et al, (2009). “Changes in serum cortisol and prolactin associated with Acupuncture during controlled ovarian hyperstimulation in women undergoing in-vitro fertilization-embryo-transfer treatment”. Fertility & Sterility, article in press. Most current research …

How to choose an Infertility Acupuncturist Standard of Care How to choose an Infertility Acupuncturist

ABORM The ABORM Board Certifies Acupuncturists who specialize in the treatment of male and female infertility via a rigorous certification examination that measures their knowledge base in western REI, and Traditional Chinese Medicine as it relates to Infertility. ABORM Fellows are experienced, highly trained, certified, and up-to-date on the very latest in evidence-based CAM treatments for Infertility. They can be an invaluable resource for your practice and your patients. www.aborm.org

Acupuncture and ART Increases blood profusion to the uterus Reduces ectopic rates Reduces miscarriage rates Reduces stress levels Reduces the level of inflammatory cytokines Relaxes spasms Most Important: Increases live births

In Conclusion Patient Satisfaction Quality control of acupuncturist’s involvement with existing treatment Improved treatment outcomes Source for future referrals Distinguishing your clinic -Patients will feel more confidant when their RE knows about CAM and how best to utilize them within the scope of practice -By establishing a relationship with an ABORM certified practitioner you know your patients are working with a certified acupuncturist who has a standardized training and is up-to-date on the latest in evidence-based CAM treatments for Infertility as well as having an understanding of Western protocols. -Research shows that IVF with pre and post transfer acupuncture treatments is more likely to lead to pregnancy than with out any acupuncture at all. -Many people will choose to work with an acupuncturist before seeking and RE and they can and are a referral source for many RE clinics -In 2001 American spent 10 billion on CAM, in 2008 33.9 billion, this is a growing field and having knowledge on where to refer your patients to will distinguish you with your patients.